孕婦接受羊膜穿刺檢查動機與遺傳諮詢成效之探討

Abstract

羊膜穿刺是目前產前診斷中最常被拿來確認胎兒健康狀態的檢查。近年來生育率下降，孕婦希望以最佳產檢方式確認下一代的健康狀態是可以預期的。羊膜穿刺已不復是高齡孕婦才會做的檢查，非高齡孕婦（＜34歲）不論母血篩檢異常與否，施行羊膜穿刺檢查人數也大幅上升，瞭解非高齡孕婦接受羊膜穿刺的動機及其相關因素是必須的。由於孕婦對於羊膜穿刺檢查認知不足，會導致不必要的焦慮與害怕，造成不佳的孕程經驗。提供遺傳諮詢可使孕婦對於羊膜穿刺檢查有正確的認知，減少不必要的焦慮。 本研究目的為瞭解孕婦接受施行羊膜穿刺檢查的動機，與給予遺傳諮詢後之成效。本研究於某婦產科診所進行，研究對象為準備接受羊膜穿刺檢查的孕婦150位，其中高齡孕婦73位，非高齡孕婦77位，收集之資料包括孕婦之基本資料、影響因素、動機因素、對羊膜穿刺的認知，與給予羊膜穿刺術相關之遺傳諮詢後，再填寫遺傳諮詢之成效評估相關資料。 研究結果顯示：比較孕婦接受羊膜穿刺的動機，發現高齡孕婦接受羊膜穿刺依序為高齡、害怕生出缺陷兒、醫師建議、配偶支持，而非高齡孕婦則為害怕生出缺陷兒、配偶支持、醫師建議、自己想做、母血篩檢陽性。孕婦對羊膜穿刺檢查的知識顯示，遺傳諮詢對羊膜穿刺檢查的認知，有大幅的提升，對高齡組孕婦的幫助更為顯著。接受遺傳諮詢後成效顯示，孕婦認為遺傳諮詢有存在的必要性，可以有效的幫助解決疑惑與減輕焦慮的情形，且遺傳諮詢在高齡孕婦的成效優於非高齡孕婦。

At present, amniocentesis is the most commonly used method of prenatal diagnosis to confirm the health status of fetus. The birth rate has decreased dramatically in recent years, it’s predictable for pregnant women to confirm the health status of fetus by using the most reliable way. Amniocentesis is no longer restricted to the advanced maternal aged (AMA) women, but also for those non-advanced maternal aged (non-AMA) (＜34 years old) women who have maternal serum α-fetoprotein screening positive result or not. Non-AMA women have made the numbers of amniocentesis increased. It’s necessary to find out the motives and relevant factors of non-AMA women who accept the amniocentesis. Due to knowledge deficit, anxieties and fears would lead to stressful pregnant experiences. The genetic counseling can provide correct knowledge of amniocentesis, and to lower the anxieties accordingly. This study was aimed to understand the factors affecting women’s acceptance of amniocentesis and the effectiveness of the genetic counseling. Data were collected at a private obstetric clinic. Study subjects were 150 women arranged to undergo amniocentesis, including 73 AMA women and 77 non-AMA women. Information on women’s basic data, influence factors, motive factors, and knowledge of amniocentesis was collected. After genetic counseling, the effectiveness of the genetic counseling was assessed. The finding of the study was that comparing the motive factors about women’s accepting amniocentesis, AMA women in order were advanced age, fear to have a defect baby, physician’s suggestion, spouse support, whereas, for non-AMA woman, in order were fear to have a defect baby, spouse support, physician’s suggestion, self’s decision, positive result of maternal serum α-fetoprotein screening. The knowledge of amniocentesis showed that the non-AMA women were better than the AMA women. After genetic counseling, all of AMA and non-AMA women got full marks. It showed the genetic counseling had positive effect in raising the cognition abort amniocentesis, and the help was more apparent to AMA women. The effectiveness of the genetic counseling showed genetic counseling was necessary to help solving uncertainty and lowering the anxieties accordingly, and it was better in AMA women than non-AMA women.